By Amy Tenderich
1. How to Recognize a Carbohydrate
In this series, Amy passes on some wisdom she's picked up about “carbs” and how to keep them under control for good diabetes management.
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Not sure what a carb is? Here’s the basic definition:
Carbohydrate = the sugars and starches found in grains, fruits, vegetables, and dairy products.
This includes all sugary foods like sweets, fruit, and sugar itself, along with grains and starchy foods (pasta, potatoes, rice) that break down to glucose in your body.
To reiterate: carbohydrates are ALL the foods either made up primarily of sugar or those that convert to sugar in your system, including starches like potatoes, bread and pasta. Things like candy and muffins are obvious carbohydrates, but many are not so obvious.
Keep in Mind:
Most carbs have the same effect on your body, whether they’re in the form of a candy bar or a baked potato (see Tip 2 for exceptions)
“Sugar-free” is not carb-free—don’t let marketing labels fool you into believing that some carbs “don’t count”
Fiber does the trick—high fiber content in a food (more than 5 grams per serving) can reduce the impact of the carbohydrate of that food on your BG (blood glucose)
As a diabetic, it’s critical for you to be aware of the carbohydrate content of your food, because limiting carbohydrates is an important tool for regulating both your daily BG levels, and your A1C over time.
2. Good and Bad Carbs Really Do Exist
While it’s true that most of our commonly eaten carb foods have similar effects on your BG, some do have advantages over others. These advantages stem from containing fiber (which slows absorption of the sugar content) and other nutrients, present especially in fruits and vegetables. These extra-beneficial carbohydrates tend to be in the group of foods with a so-called “low glycemic index.”
The Glycemic Index (GI)
The Glycemic Index (GI) is an attempt to scientifically determine the impact of individual foods on your BG levels. Here’s how it’s calculated:
To set the GI value of a particular food, say a slice of bread, ten volunteers eat 50 grams (about 2 ounces) of the bread in the morning after fasting, and their BG is measured over the next two hours. The total rise in glucose during this two-hour time period is calculated. Several days later, the same 10 volunteers drink 50 grams of glucose, and have their BG measured in the same way over the next two hours. Then the two glucose sums are compared, and the difference in value between the test food and the ingested glucose becomes the GI value for the tested food. You can find the GI value of hundreds of foods in a database maintained by the University of Sydney, Australia, at www.glycemicindex.com.
You can even submit samples of a food, along with a check, and the research team will measure its GI for you.
What’s important to know here is that foods with lower GI values have a lesser impact on your BG in the first two hours after you’ve eaten them. They take longer to absorb into your system, so they are generally good choices for people with diabetes. (Low-GI carbohydrate foods are otherwise known as “slow-acting carbs.”)
Using GI in Real Life
As simple as it sounds, the Glycemic Index isn’t so easy to utilize in real life. Foods don’t always affect your BG the way you would expect them to based on their GI value, due to a number of variables:
Most of your food is not eaten directly after fasting, as it was during the GI testing.
In real life, foods are eaten in various combinations and amounts, and the method of cooking (boiling, grilling, baking).
The age of the food also changes the GI impact.
For these reasons, lots of people don’t use the Glycemic Index, but rather work to keep their carb intake down by focusing on eating more fiber, fruits, and vegetables.
It’s also important to know that real, unprocessed foods will always be better for you than any fabricated “low-carb” product. That stuff is often extremely high in fat and chemicals, and has in some cases even been altered specifically to be indigestible, so that your so-called “free” chocolate will create a nasty stomachache.
3. How to Avoid Carb Overload
Carbohydrates actually comprise the main source of energy for your body, but eating too many can overwhelm your sluggish insulin response system. That’s why it’s important to spread out your carb intake throughout the day, rather than loading up on them all at once.
The trouble is that so many of our typical meals contain far too much fat, and almost all carb: chili with French Fries, spaghetti with garlic bread, cereal with toast and juice. These are all examples of ALL-CARB meals.
What's a Balanced Meal?
Everyone talks about eating balanced meals. But do you really know what a “balanced meal” is? It’s a mix of carbohydrate foods, alongside protein and fibrous foods like beans and vegetables—ideally not too much of anything at one sitting.
Achieving balance means learning to “mix it up” a little. It helps to keep thinking about places where you can swap a healthy protein choice for one of those high-carb choices. For example, instead of high-carb breakfast* cereal with fruit and yogurt, try scrambled eggs with a little fruit and yogurt on the side. Or for dinner, instead of pasta with garlic bread, try a lean meat accompanied by a slice of bread or two (not more).
About breakfast: it is true what they say about it being the “all-important” first meal of the day. Eating breakfast jump-starts your energy and your metabolism (your body’s food-processing system) for the day. Research studies even show that people who’ve successfully lost weight and kept it off for over a year are those who consistently eat a reasonable, healthy breakfast every day.
4. How to Learn and Practice Carb Counting
Carb counting is a tool for managing your BG levels by calculating the precise amount of carbohydrates you are eating at each meal and snack. It is used intensely by many people with Type 1 diabetes to set the appropriate insulin doses for the food they eat.
Here’s how it works: Carbohydrate in foods is measured in grams (g). One “carb serving” is the amount of a food that contains 15 grams of carbohydrate.
People with diabetes are often advised to eat no more than 3 carb servings per meal, or 45g of carb for women; and no more than 4 carb servings, or 60g carb, per meal for men.
For calculating your carbs:
Packaged foods of course have nutrition labels that can help you understand the carb content of those foods. But to read those labels correctly, be aware:
Table sugar (sucrose) and glucose are listed separately on food labels. This doesn’t mean much. Despite the separate listing, they have the same effect on your nutrition and BG (blood glucose) levels as most carbohydrates. You’ll want to look at the total carbohydrate count instead.
The food’s listed “serving size” is key. For example, a can of soup may say it contains 30 grams of carbs per serving. Check the number of “servings” in the can! Let’s say there are 2. Then if you eat the whole can, you’ll need to DOUBLE the amount of carbohydrate listed to understand how many much you’ve eaten – in this case 60 grams of carb.
For foods that are not labeled:
You can use a kitchen scale to weigh your food, which some people find extremely helpful, especially in the beginning while they’re getting familiar with serving sizes.
You can also learn to eyeball it pretty accurately using your fist as a unit measure. Think of your fist as a ball of 15 carbs (as long as your fist isn’t unusually large).
Compare a pile of rice or pasta to your fist. If it looks about the size of one fist, it’s about 15 g of carb. Two and a half fists is about 38 carbs, and so on.
5. What a Nutritionist Can Do For You
You might want to get some help learning about food and carbohydrates. People are often afraid that a nutritionist is just going to be preachy, or send you home with a dull, tasteless meal plan. Not necessarily so.
These experts can be helpful either through a one-on-one session or through attending a group class. They have loads of answers to your questions, brochures, and even visual aids that help you picture the “right” and “wrong” carbohydrate choices for optimized diabetes management.
You could also say a nutritionist's job is to "help improve your relationship with food." Their job is to help you find the good-for-you foods that you actually enjoy eating, and focus on building out those healthy habits.
Most health plans will cover all or part of the cost for seeing a nutritionist, as nutrition counseling has proven extremely helpful for people with diabetes. Your primary doctor may have some good recommendations for you too, or perhaps you can ask a friend who knows a good nutritionist.
Between Nutritionist Vs. Dietitian
These titles are often used interchangeably. While there is some difference in their training and expertise, essentially the job of both is to advise people on the health impact of their food choices, and help them make better choices for their individual health needs.
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